Multiple Myeloma: Specialists and Information

The exact causes of this malignant disease remain largely unknown. In some cases, close exposure to ionizing radiation from radioactive substances is thought to be a contributing factor. Exposure to pesticides is also discussed as a possible cause.

Age is also among the accepted risk factors for multiple myeloma. Most cases of the disease occur after the age of 45. The average age at diagnosis is as high as 70 years.

Other risk factors include:

• being male,
• African American ancestry, and
• a family history of multiple myeloma in first-degree relatives.

Other factors currently under discussion as potential risk factors include

• severe obesity and an unhealthy diet low in fruits and vegetables, as well as
• immune system disorders such as AIDS or herpes zoster (shingles).

Normally, plasma cells undergo a maturation process after coming into contact with a corresponding antigen. These antigens include, for example, viral or bacterial components. Although plasma cells can no longer divide after this process, they are able to produce antibodies—that is, substances that defend against the antigens.

In contrast to these plasma cells, dysplastic plasma cells—which proliferate in the bone marrow in multiple myeloma—divide uncontrollably.

They also produce large amounts of paraproteins or free light chains. These are proteins that are very similar in structure to antibodies. However, they cannot perform any function in the immune system and are therefore useless.

Due to the rapid proliferation of the abnormal plasma cells, the normal blood-forming cells of the bone marrow no longer have room. They are displaced. The abnormal plasma cells also attack the bone tissue.

This malignant disease develops gradually and does not show distinct symptoms until later stages of the disease. Before that, many patients suffer from nonspecific general symptoms such as feelings of weakness or weight loss.

Changes in Blood Count

Bone marrow function is impaired due to the infiltration of the bone marrow and the resulting displacement of healthy blood-forming cells. The result is anemia, which can manifest through the following symptoms:

• Shortness of breath
• Heart palpitations during exertion
• Headaches
• Difficulty concentrating
• Paleness

If not only the red blood cells but also the white blood cells (leukocytes) are reduced, this is referred to as leukopenia. Leukocytes are responsible for fighting off pathogens. If the white blood cell count in the blood is significantly reduced, the patient is at an increased risk of infection.

Like leukopenia, thrombocytopenia can also be a consequence of multiple myeloma. A deficiency of thrombocytes, or blood platelets, can lead to an increased tendency to bleed. Patients suffer from frequent nosebleeds or develop bruises easily.

A blood count may therefore reveal a deficiency of

• red blood cells,
• white blood cells, and
• platelets

. In contrast, the blood contains elevated levels of defective immunoglobulins. These can significantly increase the viscosity (thickness) of the blood. The thickened blood serum leads to circulatory disturbances in the small blood vessels. This impaired microcirculation can manifest as

• dizziness,
• dizziness,
• visual disturbances, or
• headaches

.

Bone loss

The abnormal plasma cells communicate with osteoclasts and osteoblasts through various pathways. These cells are responsible for bone metabolism and physiological bone remodeling. The plasma cells increasingly stimulate the bone-resorbing osteoclasts while simultaneously inhibiting the activity of the bone-forming osteoblasts. This leads to the breakdown of bone tissue, resulting in bone pain and an increased risk of fractures.

A typical X-ray finding in multiple myeloma is the so-called “shotgun skull,” which results from numerous small areas of osteolysis in the skull bone. When the vertebral bodies are affected by osteolysis, patients develop back pain at an early stage. Due to the patients’ advanced age, these changes are often misdiagnosed as degenerative age-related changes. Often, it is only after several attempts at treatment that diagnostic imaging is performed, which then leads to a definitive diagnosis.

The increased breakdown of bone tissue can lead to an excess of calcium in the blood. In medical terminology, this phenomenon is known as hypercalcemia.

In the kidneys, this leads to increased water and sodium loss. The glomerular filtration rate of the glomeruli decreases. Ultimately, this results in kidney failure, exacerbated by the deposition of light chains.

Based on the current state of research, a cure is not possible. The goal of therapy is therefore to alleviate symptoms and prolong life.

Patients who are asymptomatic generally do not need immediate treatment. However, regular monitoring is recommended so that treatment can be initiated promptly at the first sign of symptoms.

In cases of

• elevated blood calcium levels,
• kidney failure,
• anemia, and
• bone involvement

, immediate treatment is required. General symptoms such as night sweats or weight loss, as well as increased blood viscosity, are also indications for treatment.

For patients under 70 years of age, intensified treatment regimens are preferred. The standard treatment is high-dose therapy with an autologous blood stem cell transplant. In this case, patients typically receive combination therapy consisting of cytostatic drugs and corticosteroids.

In an autologous stem cell transplant, doctors harvest stem cells from the patient’s bone marrow. After chemotherapy, these are reinfused into the patient. In many cases, this allows for the rapid regeneration of blood cell production.

In rarer cases, stem cells from a unrelated donor are transplanted. This is known as an allogeneic stem cell transplant.

Patients over the age of 70 usually receive conventional chemotherapy. Even if the treatment is successful, there is a high risk of recurrence. This means there is a higher probability of the disease returning. Medications such as bortezomib or thalidomide are intended to delay relapse and are therefore used as maintenance therapy.

As supportive therapy, patients often receive bisphosphonates, which are intended to slow bone loss. They can also relieve pain caused by osteolysis. Radiation therapy to the affected bones may also be performed to relieve pain.